DETECTION AND CHARACTERIZATION OF HEPATIC-TUMORS - VALUE OF COMBINED HELICAL CT HEPATIC ARTERIOGRAPHY AND CT DURING ARTERIAL PORTOGRAPHY

OBJECTIVE. The purpose of our study was to evaluate the diagnostic acc uracy of combining helical CT hepatic arteriography (CTA) with helical CT during arterial portography (CTAP) for detecting and characterizin g hepatic tumors. MATERIALS AND METHODS. From January 1994 to Septembe r 1995, combined helical CTA and CTAP were performed in 52 patients (3 8 men and 14 women, 37-83 years old [mean, 64.1 years old]) with suspe cted primary or metastatic hepatic tumors before they were evaluated f or hepatic resection. Retrospectively, two radiologists reviewed the C TAP images alone and subsequently matched CTA and CTAP images. The rad iologists recorded a confidence level on a five-point scale for their evaluation of visible perfusion abnormalities as true lesions, and dia gnostic accuracy was assessed using receiver-operating-characteristic analysis. Using the data sets obtained at the interpretation sessions by the radiologists, we determined sensitivities for CTAP alone and fo r combined CTA and CTAP in 28 malignant hepatic tumors that were confi rmed in 19 patients who underwent definitive surgery. RESULTS. CTA rev ealed one hepatocellular carcinoma in a patient with severe cirrhosis and six adenomatous hyperplasias in another cirrhotic patient that CTA P failed to reveal. In comparison with CTAP alone, the combination of CTA and CTAP allowed significantly more accurate detection of lesions (area under receiver-operating-characteristic curve: 0.889 for CTAP al one versus 0.954 for CTA and CTAP combined, p < .01). The combination of CTA and CTAP also significantly raised the accuracy for characteriz ing hepatic tumors. Sensitivities far malignant hepatic tumors reveale d in the 19 patients who underwent surgery were identical: 93% (26 of 28 tumors) with CTAP alone and with CTA and CTAP combined. CONCLUSION. Although combining CTA and CTAP does not significantly increase sensi tivity for detecting hepatic tumors, the combined techniques significa ntly raise specificity in detecting hepatic rumors and accuracy in cha racterizing hepatic tumors.